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NPI Code Detail

MEDICARE: ROBERTO CORRAL PA

MEDICARE: ROBERTO CORRAL PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA00380TX

General Provider Information

NPI Number : 1528065224
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTO CORRAL PA
Provider Business Mailing Address
First Line : 1831 S GENERAL MCMULLEN DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78226-1190
Country : US
Telephone Number : 210-434-1400
Fax Number : 210-431-7472
Provider Business Practice Location Address
First Line : 1831 S GENERAL MCMULLEN DR
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78226-1190
Country : US
Telephone Number : 210-434-1400
Fax Number : 210-431-7472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 06/25/2012

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Directions to “ ROBERTO CORRAL PA” Practice Location

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